The MSTP is not a 400-meter dash or even a 5K, and many who enter this path accept the challenge of the marathon-like endurance to get through a program that lasts nearly a decade. In many ways, getting to the clinical years of the MSTP is like mile 20 of a marathon: you’ve done most of the race, but the last portion can remain daunting. And yet, it can be the most exciting time of the program given that it will likely shape the next decade or more of your life. Having recently finished my third year of medical school, I took some time to reflect on the strengths and struggles the year offered after transitioning from PhD and preparing for residency.

Of relevance to 3^rd year, the MSTP seems to have a unique culture within the medical school and in the various graduate departments aiming to manage both research and clinical endeavors. However, the graduate phase and clinical experience taken outside of the MSTP context can be quite different. The biggest difference I encountered upon entering third year was the culture between basic science research and clinical medicine. On the face, these seem pretty similar: both are interested in academic rigor, research, education, and mastery of field-specific skills. What seemed different, however, was the autonomy and direction of your training. In graduate school, you are often creating this direction with your own autonomy. And if not you, in partnership with your PI, lab mates, or other personal. In the clinical world, this is often determined by your residents, fellows, or attendings, often outside of your autonomy. What this taught me was to be flexible in a given day what was asked of me, the study goals I set, and any left-over time for other aspects of life. To me, this boiled down to managing three things: a clinical workday, studying, and family. Everything else became minimized given the limited time. Others may be able to handle more or have different priorities. I found given time constraints, I could handle one additional aspect of life (e.g. hobby, research, exercise, etc.) to studying & a workday.

The second concept regarding third year that stands out is the topic of having a PhD. Understandably this is of importance to many people, however, colleagues and supervisors on the wards may have similar, indifferent, or countering opinions. In my experience, the PhD definitely gave me time to mature as a person. I didn’t feel as anxious in the hospital, rude clinical comments that may have bothered me before mattered less, and I felt more confident answering questions with my opinion. But what the PhD did not do for me is teach me about being a good clinician: taking a great history, doing a proper physical, refining your differential diagnosis thought process, sculpting a great clinical plan. Therefore, despite the benefits of the PhD experience, what I found personally useful for improving medical mastery was to assume minimal gain in clinical skills from the experience and begin working on improving these competencies like any other clinical student.

How can one acquire these skills? There is no single solution. Some people prepare before going back to medical school, some people wing it, some people learn as they go. From my own experience with third year, I found learning by imitation from medical students, residents, fellows, and attendings was the most effective strategy for improving my clinical competence. I think the most helpful individuals were often other medical students. They seemed to be sharper, more knowledgeable, and often very thoughtful on the clinical questions I was interested in. These individuals from all clinical levels performed duties I found admirable, so I started 3^rd year by observing those who I thought acted in manners that I hoped to emulate one day. There were many examples including seeing patients interviewed a particular way, giving calm to a distressed patient with body language, nailing an oral presentation on rounds, or using analogies when educating patients. Seeing these clinical examples created positive feedback that forced me to read up on various clinical components and gave me dozens if not hundreds of real-time examples of knowledge, behaviors, and skills I could try to progress towards.

Another big concept that I attempted to do throughout third year was to try to give every clerkship a fair shot as if I would go into that area for residency. Even though in my own experience I felt I leaned towards surgery, my time in the MSTP taught me that interests can often change and that keeping an open mind can be one of the best activities for emerging opportunities. For example, I thought I was 100% set on internal medicine when I joined the MSTP. I had it all planned: PSTP in medicine, get a hematology-oncology fellowship, do a 3-year postdoc, get a grant, start a lab, live happily ever after. There was only one problem: I fell in love with surgery. So, I switched paths. Knowing that my own interest had changed during the course of a PhD gave me the evidence to keep open-minded when I was on rotations like OBGYN or primary care. After the end of these rotations, I realized I wouldn’t pursue them, however, I believe I benefitted from them more by leaving the door open to potentially go into these areas as residents and attendings seemed more willing to teach and give advice for careers in medicine.

So, once you’re in third year, what are the actual specific details that can be done to get through the clerkships? At the most basic level, I tried to be a minimalist. This meant I used as few resources as possible and then I stuck with them all year. This may not work for everyone, but I felt it provided me a habit that I could rely on throughout third year. I had three broad categories of resources: spaced-repetition for daily knowledge practice/recall, a simulation tool (question bank) for the shelf exam, and lastly a text-like resource for referral when the first two didn’t seem sufficient or I needed more information for presentations, in-house exams, or working up a complicated patient. For me, this was Anki, UWorld & AMBOSS question banks, and AMBOSS knowledge library. The specific resources listed here aren’t as important I believe as the approach of minimization and sticking with resources consistently.

To conclude, interests may change during third year which may overlap with your PhD or it may have nothing to do with it at all. I’ve seen many MSTP individuals continue clinically in areas similar to their previous research and others switch fields completely very successfully over the years. Whichever path you choose, third year gives a great opportunity to explore that question of: ‘What do I want to do next?’ The rigorous habits and thought processes one accrues during graduate school seem to be a valuable commodity in essentially every field of medicine and therefore finding where one may hope to apply such skills can be an exciting time to explore during third year.

Article by Tyler Guinn, MS3.